Hives After Abrupt Discontinuation of Quetiapine (Seroquel)
Yes, patients taking quetiapine (Seroquel) can develop hives if the medication is stopped abruptly, as this is one of several possible withdrawal symptoms that can occur.
Withdrawal Symptoms from Quetiapine
- Abrupt discontinuation of quetiapine can lead to various withdrawal symptoms including somatic symptoms such as nausea, vomiting, agitation, restlessness, diaphoresis (sweating), irritability, anxiety, dysphoria, sleep disturbance, insomnia, tachycardia, hypertension, and dizziness 1
- Skin reactions including hives (urticaria) can occur as part of the withdrawal syndrome when psychotropic medications like quetiapine are stopped suddenly 2
- Withdrawal symptoms are more likely to occur with rapid cessation rather than gradual tapering of the medication 1
Risk Factors for Withdrawal Symptoms
- Long-term use of quetiapine (months to years) increases the risk of withdrawal symptoms 1
- Higher doses of quetiapine are associated with more severe withdrawal symptoms 1
- Previous history of medication sensitivity or withdrawal reactions may predispose patients to experiencing hives after quetiapine discontinuation 3
Management of Hives After Quetiapine Discontinuation
Initial Assessment and Treatment
- Evaluate the severity of hives based on extent: mild (less than 3 hives), moderate (3-10 hives), or severe (generalized involvement) 4
- For mild to moderate hives, begin treatment with a non-sedating H1 antihistamine such as cetirizine, desloratadine, fexofenadine, levocetirizine, or loratadine 4
- Apply cooling antipruritic lotions such as calamine or 1% menthol in aqueous cream for symptomatic relief 4
- Advise patients to avoid potential aggravating factors such as overheating, stress, and alcohol 4
For Inadequate Response
- Consider increasing the dose of the non-sedating H1 antihistamine above the licensed recommendation when benefits outweigh risks 4
- Add a sedating antihistamine at night (e.g., chlorphenamine 4-12 mg or hydroxyzine 10-50 mg) to help with sleep disruption 4
- Adding an H2 antihistamine may provide better control than an H1 antihistamine alone 4
For Severe or Refractory Cases
- Short courses of oral corticosteroids such as prednisolone may be necessary for severe cases of hives 4
- Adding montelukast (an antileukotriene) may be considered for refractory cases 4
Prevention of Withdrawal Symptoms
- Gradually taper quetiapine rather than stopping it abruptly to minimize withdrawal symptoms 2
- In cases where withdrawal symptoms have previously occurred, pretreatment with appropriate medications (such as antihistamines for hives) may help prevent recurrence 5
- For patients who must discontinue quetiapine, close monitoring is recommended, especially in the first few days after discontinuation 1
Important Considerations
- Patients should be advised that recurrent urticaria may occur over 1-2 days following the initial episode 4
- Schedule follow-up visits to assess treatment response and adjust management as needed 4
- In severe cases with systemic symptoms beyond hives, emergency medical attention may be required 3
- Consultation with a specialist (allergist or dermatologist) may be beneficial for persistent or severe cases 3